CPT code 35551 is used to identify a specific medical procedure involving an artery bypass graft, aiding in the standardization of healthcare services.
CPT code 35551 is used to describe a surgical procedure involving an artery bypass graft. This procedure is typically performed to redirect blood flow around a blocked or narrowed artery, often in the context of peripheral artery disease. The goal is to improve blood circulation to a specific area of the body, usually the legs, by creating a new pathway for blood to flow using a graft. This graft can be made from a vein taken from another part of the patient's body or a synthetic material. The procedure helps alleviate symptoms such as pain and can prevent more serious complications like tissue damage.
For CPT code 35551, which pertains to an artery bypass graft, the following modifiers may be applicable depending on the specific circumstances of the procedure and the billing requirements:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: This modifier is applied when multiple procedures are performed during the same surgical session. It indicates that multiple services were provided and helps in the appropriate allocation of reimbursement.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team. It indicates that multiple professionals were involved in the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician performs a procedure or service more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by another physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with payer guidelines and the specific circumstances of the procedure. Proper documentation is essential to support the use of any modifier.
CPT code 35551 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, the actual reimbursement for CPT code 35551 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this specific procedure. Healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding reimbursement for CPT code 35551.
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